Gynaecological organ involvement in females undergoing radical cystectomy: a multicentre study.

OBJECTIVE: To report the incidence of malignancy in gynaecological organs removed during radical cystectomy (RC). PATIENTS AND METHODS: A retrospective multicentre study of 1600 RCs at three high-volume institutions between January 2009 and March 2022 was performed. Pathological findings in gynaecological organs in female RC specimens were reviewed. Multivariable logistic regression analyses were used to identify predictors of malignant gynaecological organ involvement (GOI) at time of RC. RESULTS: Overall, 302 females with a median (interquartile range) age of 68 (61-75) years underwent RC for clinical (c)Ta-T4 bladder cancer. In all, 56 patients (18.5%) received neoadjuvant chemotherapy. Malignant GOI was seen in 20 patients (6.6%); the most common single sites of GOI were the uterus (five patients) and vaginal wall (four), followed by cervix (one), and ovaries (one). Nine patients had involvement of more than one gynaecological organ. No females had a primary gynaecological malignancy detected incidentally at RC. Patients with GOI were more likely to have cT3/T4 stage (P < 0.001), preoperative hydronephrosis (P = 0.004), lymphovascular invasion (P = 0.002), and squamous cell carcinoma (P = 0.005) than those without GOI. On multivariable analysis, cT4 stage was an independent predictor of malignant GOI (odds ratio 88.3, 95% confidence interval 10.1-1214; P < 0.001). CONCLUSION: To our knowledge, we present the largest multi-institutional study examining malignant GOI in females with bladder cancer undergoing RC. The rate of GOI at the time of RC is low and associated with higher clinical stage. In the absence of clinical or radiological evidence of sexual organ involvement, our results do not support their routine removal at the time of RC.

Predictive Factors for Time to Progression after Hyperthermic Mitomycin C Treatment for High-Risk Non-Muscle Invasive Urothelial Carcinoma of the Bladder: An Observational Cohort Study of 97 Patients.

INTRODUCTION: Hyperthermic mitomycin (HM) is a novel treatment modality for selected patients with high-risk non-muscle invasive bladder cancer (NMIBC). We sought to determine predictors of response to this therapy. PATIENTS AND METHODS: A longitudinal, cohort study of 97 patients with high-risk NMIBC treated with ≥4 HM instillations on a prophylactic schedule was conducted. The primary outcome was time-to-progression survival; secondary outcomes were overall survival, cancer-specific survival, and adverse events. Descriptive statistics, Kaplan-Meier survival analyses, Cox proportional hazards modelling, and univariate and multivariable regression were performed. RESULTS: The presence of initial complete response (CR; no evidence of disease at first check video-cystoscopy and urine cytology) post-HM treatment was an independent predictor of good response to HM. Female patients and those without carcinoma in situ (CIS) also appeared to respond better to the intervention. The overall bladder preservation rate at a median of 27 months was 81.4%; 17/97 (17.5%) patients died during the course of the study. CONCLUSIONS: High-risk NMIBC patients can be safely treated with HM and have good oncological outcome. However, those without an initial CR have a poor prognosis and should be counselled towards adopting other treatment methodologies such as cystectomy. Female gender and lack of CIS may be good prognostic indicators for response to HM.

Spontaneous bladder rupture of a urinary bladder with non-muscle invasive bladder cancer.

We describe the case of a 65-year-old man who developed spontaneous bladder rupture after picking up his suitcase from a squatting position. He was known to have non-muscle invasive bladder cancer (NMIBC), managed previously with transurethral resections and intravesical chemotherapy. CT scan showed a large amount of free intraperitoneal fluid anterior to the bladder, suggestive of a urinoma. Management was initially conservative, with insertion of urethral catheter, intravenous antibiotics and fluid resuscitation. Follow-up CT scan showed resolution of the urinoma with the patient making a full recovery after 3 weeks.

Maximum urethral closure pressure and sphincter volume in women with urinary retention.

PURPOSE: In 1988 a syndrome of isolated urinary retention in young women that is associated with electromyographic abnormality of the striated urethral sphincter was described. It was hypothesised that urinary retention resulted from a failure of sphincter relaxation. The electromyographic abnormality causes overactivity of the muscle and may induce changes of work hypertrophy. If the hypothesis that the electromyographic abnormality is the cause of urinary retention is correct, we would expect the urethral sphincter to be enlarged and the urethral pressure profile to be increased in these women. We evaluated the role of static urethral pressure profilometry and transvaginal ultrasound in women in urinary retention. MATERIALS AND METHODS: A total of 66 women in complete or partial urinary retention underwent electromyography of the striated urethral sphincter using a concentric needle electrode, followed by urethral pressure profile and/or urethral sphincter volume measurement by transvaginal ultrasound. RESULTS: Maximum urethral closure pressure plus or minus standard deviation was significantly increased in patients with versus without the electromyographic abnormality (103 +/- 26.4 versus 76.7 +/- 18.4 cm. water, p <0.001). Maximum urethral sphincter volume was also increased in women with versus without the abnormality (2.29 +/- 0.64 versus 1.62 +/- 0.32 cm.3, p <0.001). CONCLUSIONS: The results of this study are consistent with the hypothesis that a local sphincter abnormality is the cause of urinary retention in a subgroup of women. Urethral pressure profilometry and sphincter volume measurement are useful for assessing these cases, especially when sphincter electromyography is not readily available.

The cause and natural history of isolated urinary retention in young women.

PURPOSE: Using a questionnaire mailed to patients we evaluated the course and natural history of urinary retention in women, of which the cause is attributed to electromyography abnormality of the striated urethral sphincter. Previously urinary retention in young women has often been considered to be due to multiple sclerosis or a manifestation of a psychogenic disorder. MATERIALS AND METHODS: A questionnaire was mailed to 216 women with abnormal sphincter electromyography and urinary retention. Of the 112 responses we analyzed the 91 from those who had been in complete urinary retention. RESULTS: Mean patient age at the onset of complete retention was 27.7 years (range 10 to 50). No patients had neurological features indicating a cauda equina lesion or central demyelination and none had progressed to features of a general neurological disorder. Mean maximum bladder capacity at the initial episode of complete retention was 1,208 ml. Of the women 65% reported an event that had apparently precipitated urinary retention, most commonly a gynecologic surgical procedure using general anesthesia. Sacral neuromodulation was the only therapeutic intervention that restored voiding. CONCLUSIONS: The concept of an organic cause of urinary retention in otherwise healthy young women has considerable importance in terms of correct management. Neurological investigation in these women does not reveal underlying neurological disease. It is thought that this disorder is due to a primary failure of relaxation of the striated urethral sphincter.